Characterization of antimicrobial resistance and class 1 integrons in Enterobacteriaceae isolated from Mediterranean herring gulls (Larus cachinnans).

Mediterranean herring gulls (Larus cachinnans) were investigated as a possible reservoir of antibiotic resistant bacteria and of cassette-borne resistance genes located in class 1 integrons. Two hundred and fourteen isolates of the family Enterobacteriaceae were collected from cloacal swabs of 92 chicks captured in a natural reserve in the North East of Italy. They showed high percentages of resistance to ampicillin and streptomycin. High percentages of resistance to trimethoprim/sulfamethoxazole were found in Proteus and Citrobacter and to chloramphenicol in Proteus. Twenty-two (10%) isolates carried the intI1 gene. Molecular characterization of the integron variable regions showed a great diversity, with the presence of 11 different cassette arrays and of one integron without integrated cassettes. The dfrA1-aadA1a and aadB-aadA2 cassette arrays were the most frequently detected. Also the estX cassette, alone or in combination with other cassettes, was detected in many isolates. From this study it is concluded that the enteric flora of Mediterranean herring gulls may act as a reservoir of resistant bacteria and of resistance genes. Due to their feeding habits and their ability to fly over long distances, these free-living birds may facilitate the circulation of resistant strains between waste-handling facilities, crops, waters, and urban areas.

Mycobacterium tuberculosis isolates belonging to katG gyrA group 2 are associated with clustered cases of tuberculosis in Italian patients.

Fifty-one consecutive isolates of Mycobacterium tuberculosis, collected during a 2-year period in the north-east of Italy, were subjected to IS6110-RFLP analysis to detect the presence of clusters and assigned to one of the three genotypic groups delineated by single nucleotide polymorphisms in the genes katG and gyrA. All the isolates collected from the local population belonged to group 2 or 3, while group 1 isolates were found only in specimens collected from African immigrants. Clustered cases of tuberculosis, which are likely to be related to recently transmitted infection, were found to be significantly associated with katG gyrA group 2. In the local situation, strains belonging to this group may therefore present a higher risk of transmission.

Antimycobacterial activity of N1-[1-[3-aryl-1-(pyridin-2-, 3- or 4-yl)-3-oxo] propyl]-2-pyridinecarboxamidrazones.

Infections caused by non-tuberculous mycobacteria and multidrug-resistant Mycobacterium tuberculosis are difficult to treat, and so new compounds potentially active against these bacteria are being sought. A series of 2-pyridinecarboxamidrazone derivatives, recently synthesized, have been evaluated for their inhibitory activity against 17 Mycobacterium avium isolates; the agar dilution method showed different degrees of susceptibility to the new molecules. Four molecules, three of which are chlorine derivatives, inhibited 94% of the strains tested with an MIC of 32 mg/L. These data indicate that these new pyridine-2-carboxamidrazones merit further study as antimycobacterial agents.

Are most ICU infections really nosocomial? A prospective observational cohort study in mechanically ventilated patients.

A prospective cohort study was undertaken with two end points: (i) to compare the 48 h time cut-off with the carrier state criterion for classifying infections, and (ii) to determine a time cut-off more in line with the carrier state concept. All patients admitted to the intensive care unit and expected to require mechanical ventilation for a period > or = 3 days were enrolled. Surveillance cultures of throat and rectum were obtained on admission and thereafter twice weekly to distinguish micro-organisms that were imported into the intensive care unit from those acquired during the stay in the unit. A total of 117 patients with median age of 61 years and median Simplified Acute Physiology Score II of 42, were included in the study. Of these patients, 48 (41%) developed a total of 74 infection episodes. Using the 48 h cut-off point, 80% of all infections were classified as ICU-acquired. According to the carrier state criterion, 44 infections (60%) were of primary endogenous development caused by micro-organisms imported into the intensive care unit. Seventeen secondary endogenous (23%) and 13 exogenous (17%) infections were caused by bacteria acquired in the unit. The carrier state classification allowed the transfer of 49% of infections from the ICU-acquired group into the import group. A time cut-off of nine days was found to identify ICU-acquired infections better than two days. These data suggest that monitoring of carriage of micro-organisms may be a more realistic approach to classify infections developing in the intensive care unit.

Characterization of oligonucleotide probes for the identification of Acinetobacter spp., A. baumannii and Acinetobacter genomic species 3.

The 16S-23S intergenic spacer regions of four Acinetobacter genomic species belonging to the A. calcoaceticus-A. baumannii (Acb) complex, i.e. genomic species 1 (A. calcoaceticus), genomic species 2 (A. baumannii), genomic species 3 and Tjernberg and Ursing (TU) genomic species 13, have been cloned and sequenced. Sequence analysis led to the discovery of a single copy of IIe and Ala tRNA genes within each spacer. Sequence comparison allowed the identification of a 192-base-pair long highly conserved sequence between the 3' end of the 16S rRNA and the 5' end of the tRNA(Ala) genes. Moreover, two short regions, which were specific to, respectively, genomic species 2 and 3, could be identified. Oligonucleotides corresponding to these sequences were constructed and tested for the ability to hybridize with chromosomal DNA extracted from Acinetobacter belonging to different genomic species and with chromosomal DNA of other bacterial genera. One of these oligonucleotides was demonstrated to be useful as a sensitive and specific probe for A. baumannii. A less sensitive probe for Acinetobacter genomic species 3 was also developed.

Characterization of the phenotype conferred by two different rpsL alleles coding for streptomycin dependence.

Two streptomycin-dependent strains of E. coli B showing different phenotypes were isolated. They carried different rpsL alleles which conferred two levels of dependence on the drug, and showed a different expression when present in heterozygous conditions with other rpsL alleles, coding for sensitivity or resistance on the drug.

Genotoxic activity of 4,4',5'-trimethylazapsoralen on plasmid DNA.

The genotoxic activities of 8-methoxypsoralen (8-MOP) and 4,4',5'-trimethylazapsoralen (4,4',5'-TMAP) on plasmid DNA have been compared. In a previous work, 4,4',5'-TMAP, a methyl derivative of a psoralen isoster, had shown potential photochemotherapeutic activity. The mutagenic activity of mono- and bifunctional lesions caused by these compounds was evaluated both after UVA irradiation, which causes the formation of both kinds of lesions, and after a two-step irradiation procedure of the psoralen-plasmid DNA complex, which allowed monoadducts and interstrand crosslinks to be studied separately. Furthermore, we used a procedure that allowed us to evaluate both the mutagenic and recombinogenic activity of the two compounds. Results indicate that the most important difference between 8-MOP and 4,4',5'-TMAP consists in their mode of photoreaction with DNA rather than in their mutagenic potential. In fact, in all of the experimental procedures, 4,4',5'-TMAP shows a lower ability than 8-MOP to generate interstrand crosslinks. However, when comparable toxicity levels are reached, the two compounds show the same mutagenic potentiality.

Improved reactivity of hepatitis C virus core protein epitopes in a conformational antigen-presenting system.

Recent studies have identified several epitopes in the N-terminal portion of the nucleocapsid protein which are predominantly recognized by sera of patients infected with hepatitis C virus (HCV). The characterization of the sequences recognized by theses antibodies and the evaluation of their reactivities have been performed mainly with synthetic peptides. However, synthetic peptides are notoriously unreliable as antigens when the immune response is directed against conformational epitopes. In order to improve the detection of antibody responses in HCV-infected patients, we have evaluated the reactivities of three immunodominant regions of the HCV core protein (residues 1 to 20, 21 to 40, and 32 to 46) displayed in a conformation-specific manner on the surface of the Flock House virus (FHV) capsid protein. The results obtained with these proteins in the analysis of 94 serum samples positive by anti-HCV enzyme-linked immunosorbent assay where then compared with those obtained with the corresponding synthetic peptides. The sequence most reactive both with the peptide and with the FHV protein was the region from residues 1 to 20, confirming the low conformational requirements for the display of these residues. On the other hand, the already reported conformational nature of residues 32 to 46 is in keeping with its observed high reactivity when displayed by the FHV recombinant protein and with the low reactivity displayed by its corresponding synthetic peptide. Finally, the high reactivity observed for the chimeric protein displaying the region from residues 21 to 40, as opposed to the results obtained with the synthetic peptide, also suggests that this sequence contains one or more conformational epitopes whose structures cannot be mimicked correctly with synthetic peptides.

PCR ribotyping for characterizing Salmonella isolates of different serotypes.

The 16S-23S intergenic spacer region in 218 strains of Salmonella isolated from four Italian hospitals during the period from 1977 to 1994 was analyzed by PCR ribotyping. This molecular typing technique allowed for the identification of seven different and specific electrophoretic profiles for the seven serovars S: enteritidis, S. london, S. anatum, S. panama, S. heidelberg, S. agona, and S. goldcoast. Otherwise, the spacer region appears to be polymorphic in S. typhimurium S. infantis, and S. derby since we could identify eight, six, and four different ribotypes, respectively.

Identification of Acinetobacter isolates in the A. calcoaceticus-A. baumannii complex by restriction analysis of the 16S-23S rRNA intergenic-spacer sequences.

Members of the genus Acinetobacter are reported to be involved in hospital-acquired infections with an increasing frequency. However, clinical laboratories still lack simple methods that allow complete identification of some pathogenic species, i.e., those corresponding to A. baumannii (DNA group or genospecies 2), unnamed genospecies 3 and 13, and two new genospecies that have recently been described. In fact, a complete discrimination between these species is possible only by DNA-DNA hybridization or ribotyping. Both of these techniques are complex and time-consuming and cannot be performed in most clinical laboratories. As a consequence, isolates belonging to these genospecies are often not differentiated and included, together with the environmental genospecies 1, in the A. calcoaceticus-A. baumannii complex. In this report, a simple and rapid method for the identification of the genospecies belonging to the A. calcoaceticus-A. baumannii complex is proposed. It is based on the combined digestion by the restriction endonuclease AluI and NdeII of the DNA fragments resulting from the amplification of the 16S-23S rRNA intergenic spacer sequences. The analysis of 36 strains characterized by DNA-DNA hybridization in previous studies showed that the restriction profiles obtained are highly reproducible and characteristic for each genospecies. Moreover, extending this study to 68 clinical strains, which were assigned to the A. calcoaceticus-A. baumannii complex by phenotypic tests, confirmed the existence of a panel of limited and well-conserved restriction patterns and allowed the identification of the strains tested. This study thus proposes the detection of restriction length polymorphism in the spacer sequences between the 16S and 23S rRNA genes as a method for the identification of isolates in the A. calcoaceticus-A. baumannii complex.

Typing of Staphylococcus aureus by amplification of the 16S-23S rRNA intergenic spacer sequences.

The possibility of using polymorphisms in the spacer regions between 16S and 23S rRNA genes in order to type Staphylococcus aureus has been evaluated. To this purpose, DNA extracted from 74 independent isolates was amplified making use of a pair of primers complementary to conserved regions in the 16S and 23S genes. We have demonstrated that the method provides a good discrimination between unrelated isolates, giving better results when methicillin-sensitive strains are considered. Moreover, the amplification profiles were reproducible and all strains were typable. Given these results, and the technical simplicity of the process, we propose PCR-ribotyping to be taken into consideration as a method for typing S. aureus.

[Treatment with rufloxacin of complicated urinary tract infections]. / Trattamento con rufloxacina di infezioni complicate delle vie urinarie.

Eighteen patients of either sex (14 M; 4 F), ranging in age from 23 to 79 years, with clinical diagnosis of complicated cystitis due to Rufloxacin sensitive pathogens, were enrolled. Rufloxacin was administered orally at the dosage of 400 mg/die the first day; 200 mg/die the following 6 days or more. The mean duration of treatment was 7.25 +/- 0.78 days. No concomitant antimicrobial therapy was administered during the study. At the end of therapy 5/14 evaluable patients recovered, 9/14 evaluable patients improve; 4 patients were considered by Investigator as "not evaluable". Causative pathogens were isolated in all patients and eradicated in 18 out of 18 bacteriologically evaluable patients (eradication rate = 100%). Neither reinfections nor superinfections occurred. No clinical adverse event related to study medication was reported. The results indicate that Rufloxacin at the oral dose of 200 mg/die is well tolerated and effective in the treatment of complicated cystitis.

Structure-activity relationship in the mutagenic effect of chiral or racemic 2-bromo-propanamides on Salmonella typhimurium.

Some 2-bromo-propanamides were prepared and tested for direct mutagenicity in Salmonella typhimurium TA 100. Results confirm the mutagenic activity of 2-bromo-N-benzyl-propanamide and indicate that it is independent of enantiomeric configuration. A variation in the chemical structure, namely, the addition of a methyl group at the benzylic carbon, causes the four resulting diastereomers to be devoid of any activity. Conversely, some racemic ring-substituted methoxy and/or hydroxy derivatives of the parent compound displayed mutagenic properties, causing an increase in the number of his+ revertants up to 524 per milligram per plate.

Prevalence of recombinational versus mutational events in damaged plasmid DNA containing regions of homology with the chromosome.

Plasmid DNA modified by in vitro treatments was transformed in E. coli bacterial cells. A streptomycin-resistant strain, carrying the peculiar rpsL421 mutation, was used as a recipient for the cloning vector pNO1523, which carries the wild-type (streptomycin-sensitive) rpsL allele. Transformants were streptomycin-sensitive unless a change in plasmid sequence had occurred. The analysis of the MaeI restriction pattern of plasmids isolated from streptomycin-resistant transformants, together with the detection of the phenotype that they conferred to a streptomycin-dependent strain, allowed us to identify plasmids that had undergone recombination with the host chromosome. The number of these plasmids exceeded by far that of plasmids resulting from mutational events.

Multivariate analysis of antibiograms for typing Pseudomonas aeruginosa.

A method for typing Pseudomonas aeruginosa using antibiotic susceptibility patterns is presented, which allows recognition of clusters of the same strain among clinical isolates from different patients, thus indicating whether cross infection has occurred. An index of similarity (the euclidean or the oblique distance), which includes all the differences of disk zone sizes among isolates, is computed and then elaborated by a clustering algorithm that successively groups all the isolates in larger clusters. The results of clustering are presented as dendrograms, whose terminal branches are pruned down to a level below which differences are casual; isolates that still appear on a common branch are considered identical. The reliability of this technique for detecting nosocomial cross infections was assessed by comparing its results with that of serotyping and pyocin typing. Only 2 of 31 (6.4%) clusters detected by multivariate analysis were not confirmed, while 4 of 33 (12.1%) clusters were recognized by serotyping and pyocin typing, but not by multivariate analysis. In at least two instances the differences in susceptibility patterns were due to cytoplasmic R factors. The routine use of antibiogram data for typing purposes should be considered an essential part of nosocomial infection control.

Cluster analysis of antibiotic susceptibility patterns of clinical isolates as a tool in nosocomial infection surveillance.

Hospital infections represent a major epidemiological problem. The first step in the detection of nosocomial infections consists in assessing the probability that two or more isolates from different patients are similar or different. Many methods are available for typing purposes. Among these, antibiotic susceptibility patterns do not need extra cost or extra work and are available "on line" every moment they are needed. A mathematical technique of elaboration is proposed for disk zone sizes, in order to assess the probability of two or more clinical isolates to be the same strain. Antibiograms performed according to Kirby-Bauer are evaluated detecting zone sizes by a computer controlled device and then submitted to cluster analysis. Similarity of strains is reported in a dendrogram, in which strains are successively fused. Strains that share a common susceptibility pattern are considered a "cluster". At last, epidemiological maps are constructed for each group of strains, in which all the isolates are reported, ordered for patients, plotted on the day the specimen was collected, drawn in a different shape according to the source of specimen, and shadowed by the pattern of its cluster. This method of reporting data directly allows to detect cross infections among patients and can be used as a first typing step before other more expensive procedures.

Selective mutagenic activity of 2-bromo-propanamides on Salmonella typhimurium. A structure-activity study.

Nineteen 2-halogeno-acetamides, -propanamides, and -iso-butyramides and four related epoxyamides were tested as mutagens for Salmonella typhimurium TA100. Mutagenic activity was observed in strictly selected 2-halogenoamides and in all epoxyamides. The effectiveness of 2-halogenoamides depends upon: the character of the carbon carrying the halogen (1 degree, 2 degrees, 3 degrees); the nature of the halogen (Br, Cl); the substitution at nitrogen. Some considerations concerning the selectivity observed are presented.

Mutagenic activity of four furocoumarins: angelicin, 4,5'-dimethyl-angelicin, psoralen and 8-methyl-psoralen on V79 Chinese hamster cells.

Four furocoumarins, two having a linear structure (psoralen and 8-methyl-psoralen) and two having an angular structure (angelicin and 4,5'-dimethyl-angelicin), were studied for their mutagenic activity in the HGPRT system on V79 chinese hamster cells in culture (V79/HGPRT system). All the four drugs, when activated by near-ultraviolet (NUV) light, were effective in inducing HGPRT mutants. Their efficiency ranked in the following order: 8-methyl-psoralen greater than psoralen = 4,5-dimethylangelicin greater than angelicin.

Mutagenic activity of the dacarbazine analog p-(3,3-dimethyl-1-triazeno)benzoic acid potassium salt in bacterial cells.

The mutagenic activity of the antimetastatic agent p-(3,3-dimethyl-1-triazeno)benzoic acid potassium salt (DM-COOK) was studied in procaryotic cells and compared with that of dacarbazine (DTIC) which is clinically used in the management of human neoplasms. The results indicated that DM-COOK has a very low mutagenic activity on the Salmonella typhimurium strains tested, while it is more effective in inducing trp+ revertants in E. coli B strains. The magnitude of these effects was always less pronounced than that displayed by DTIC. The mutagenic activity of DM-COOK appeared to be independent from the addition of a metabolic activating system and had a different pattern from that displayed by MM-COOK. It is therefore unlikely that DM-COOK acts through conversion into the monomethyl derivative.